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Undermined by Altered Epidemiology: Changing Concepts in the Management of Bilharzial Urinary Bladder Carcinoma in Egyptian Population

Gamal M Saied, Hany M Mikhail and Karim G Moustafa

Background: The objective is to validate the new clinicopathological features of urinary bladder carcinoma in the Egyptian population. These are caused by altered epidemiology, and proposed to have reflection on management.

Patients and methods: Timely contributions of leading Egyptian experts in bladder cancer in the last 4 decades were reviewed. Additionally, 102 patients were studied in 2 subsets A&B based on a preplanned treatment modality: cystectomy facing transurethral resection plus radiotherapy. Observation on gross and microscopic features and their reflection on treatment decision are recorded.

Results: An overview of studies published in the last 4 decades is given, demonstrating a striking change in the characteristic features of bladder carcinoma in Egypt, more obvious in 2007 and after. In the present work, 65%of patients had their tumors in a bilharzial bladder, while 35 % had their tumors in a non bilharzial bladder, wherewalls demonstrated the classical cystoscopic features of the disease. Group A patients were treated by cystectomy carrying 7.7% perioperative mortality, whereas patients in group B received radiotherapy preceded by transurethralresection.

Conclusions: Bladder cancer in Egyptian patients has lost its peculiar features imposed by bilharzial cystitis, shifting towards traditional types suitable for organ preserving management.